Provider Demographics
NPI:1700623014
Name:SANTELLANO, SELENA (LCSWA)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:SANTELLANO
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:LUPE
Other - Last Name:SANTELLANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWA
Mailing Address - Street 1:400 W 1ST ST APT 305
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-1948
Mailing Address - Country:US
Mailing Address - Phone:254-220-8171
Mailing Address - Fax:
Practice Address - Street 1:231 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5029
Practice Address - Country:US
Practice Address - Phone:252-321-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0209141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical